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Both selective and nonselective His bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECG

Published:December 02, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.11.016

      Background

      Right ventricular myocardial pacing leads to nonphysiological activation of heart ventricles. Contrary to this, His bundle pacing preserves their fast activation. Ultra-high-frequency electrocardiography (UHF-ECG) is a novel tool for ventricular depolarization assessment.

      Objective

      The purpose of this study was to describe UHF-ECG depolarization patterns during myocardial and His bundle pacing.

      Methods

      Forty-six patients undergoing His bundle pacing to treat bradycardia and spontaneous QRS complexes without bundle branch block were included. UHF-ECG recordings were performed during spontaneous rhythm, pure myocardial para-Hisian capture, and His bundle capture. QRS duration, QRS area, depolarization time in specific leads, and the UHF-ECG–derived ventricular dyssynchrony index were calculated.

      Results

      One hundred thirty-three UHF-ECG recordings were performed in 46 patients (44 spontaneous rhythm, 28 selective His bundle, 43 nonselective His bundle, and 18 myocardial capture). The mean QRS duration was 117 ms for spontaneous rhythm, 118 ms for selective, 135 ms for nonselective, and 166 ms for myocardial capture (P < .001 for nonselective and myocardial capture compared to each of the other types of ventricular activation). The calculated dyssynchrony index was shortest during spontaneous rhythm (12 ms; P = .02 compared to selective and P = .09 compared to nonselective), and it did not differ between selective and nonselective His bundle capture (16 vs 15 ms; P > .99) and was longest during myocardial capture of the para-Hisian area (37 ms; P < .001 compared to each of the other types of ventricular activation).

      Conclusion

      In patients without bundle branch block, both types of His bundle, but not myocardial, capture preserve ventricular electrical synchrony as measured using UHF-ECG.

      Keywords

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      References

        • Abdelrahman M.
        • Subzposh F.A.
        • Beer D.
        • et al.
        Clinical outcomes of His bundle pacing compared to right ventricular pacing.
        J Am Coll Cardiol. 2018; 71: 2319-2330
        • Vijayaraman P.
        • Chung M.K.
        • Dandamudi G.
        • et al.
        • ACC’s Electrophysiology Council
        His bundle pacing.
        J Am Coll Cardiol. 2018; 72: 927-947
        • Jurak P.
        • Halamek J.
        • Meluzin J.
        • et al.
        Ventricular dyssynchrony assessment using ultra-high frequency ECG technique.
        J Interv Card Electrophysiol. 2017; 49: 245-254
        • Plesinger F.
        • Jurak P.
        • Halamek J.
        • et al.
        ventricular electrical delay measured from body surface ECGs is associated with cardiac resynchronization therapy response in left bundle branch block patients from the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy).
        Circ Arrhythm Electrophysiol. 2018; 11 (e005719)
        • Halamek J.
        • Leinveber P.
        • Viscor I.
        • et al.
        The relationship between ECG predictors of cardiac resynchronization therapy benefit.
        PLoS One. 2019; 14 (e0217097)
        • RStudio Team
        RStudio: Integrated development environment for R.
        RStudio, Inc., Boston, MA2015
        http://www.rstudio.com/
        Date accessed: September 1, 2019
        • R Core Team. R
        A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2019
        https://www.R-project.org/
        Date accessed: September 1, 2019
        • Bates D.
        • Mächler M.
        • Bolker B.
        • et al.
        Fitting linear mixed-effects models using lme4.
        J Stat Softw. 2015; 67: 1-48
        • Sweeney M.O.
        • Hellkamp A.S.
        • Ellenbogen K.A.
        • et al.
        • Mode Selection Trial Investigators
        Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.
        Circulation. 2003; 107: 2932-2937
        • Lee M.Y.
        • Yeshwant S.C.
        • Lustgarten D.L.
        Honing in on optimal ventricular pacing sites: an argument for his bundle pacing.
        Curr Treat Options Cardiovasc Med. 2015; 17: 372
        • Kypta A.
        • Steinwender C.
        • Kammler J.
        • Leisch F.
        • Hofmann R.
        Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing.
        Europace. 2008; 10: 574-579
        • Ji L.
        • Hu W.
        • Yao J.
        • et al.
        Acute mechanical effect of right ventricular pacing at different sites using velocity vector imaging.
        Echocardiography. 2010; 27: 1219-1227
        • Pastore G.
        • Zanon F.
        • Noventa F.
        • et al.
        Variability of left ventricular electromechanical activation during right ventricular pacing: implications for the selection of the optimal pacing site.
        Pacing Clin Electrophysiol. 2010; 33: 566-574
        • Jastrzębski M.
        • Moskal P.
        • Bednarek A.
        • Kiełbasa G.
        • Vijayaraman P.
        • Czarnecka D.
        His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: implications for pacemaker programming.
        Heart Rhythm. 2019; 16: 1808-1816
        • Cadrin-Tourigny J.
        • Fournier A.
        • Andelfinger G.
        • Khairy P.
        Severe left ventricular dysfunction in infants with ventricular preexcitation.
        Heart Rhythm. 2008; 5: 1320-1322
        • Beer D.
        • Sharma P.S.
        • Subzposh F.A.
        • et al.
        Clinical outcomes of selective versus nonselective His bundle pacing.
        JACC Clin Electrophysiol. 2019; 5: 766-774
        • Arnold A.
        • Shun-shin M.
        • Keene D.
        • et al.
        Left ventricular activation time and pattern are preserved during both selective and non-selective His pacing [abstract].
        Heart Rhythm. 2016; 13: S342
        • Zhang J.
        • Guo J.
        • Hou X.
        • et al.
        Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony.
        Europace. 2018; 20: 1010-1017
        • Catanzariti D.
        • Maines M.
        • Cemin C.
        • Broso G.
        • Marotta T.
        • Vergara G.
        Permanent direct his bundle pacing does not induce ventricular dyssynchrony, unlike conventional right ventricular apical pacing: an intrapatient acute comparison study.
        J Interv Card Electrophysiol. 2006; 16: 81-92